Stem Cell Therapy for Avascular Necrosis of Femoral Head in Sickle Cell Disease: Report of 11 Cases and Review of Literature

BACKGROUND AND OBJECTIVE: Sickle cell disease (SCD) is quite common in eastern Saudi Arabia and Avascular necrosis of femoral head (ANFH) occurs in 30% of the young patients leading to early joint arthroplasty. This study was conducted to assess the benefits of injection of osteoblasts in the avascular lesions of the head of femur. PATIENTS AND METHODS: A preset technique was used, 10 CC of bone marrow aspiration was performed under local anesthesia and aseptic technique. Osteoblasts were separated from the bone marrow cells. The avascular area was drilled and 10 million osteoblasts were transplanted at the lesion site. Patients were seen in the out patient clinic after two weeks for removal of the suture and addressed the questionnaire and examined for the range of movement. The follow up MRI was performed at 4 months. RESULTS: The average age was 20.2±3.9 years. The mean hemoglobin S was 81.6±4.8 percent. Quality of Life Score for Chronic Hip Disease was assessed and found at 8.6 (1 being the severe limitation and 10 being normal), whereas Harris hip score improved from 41.7±5.1 to 88.93±3.6 (p < 0.001). MRI of pre and post osteoblast implantation showed robust new bone formation and disappearance of the avascular lesions. CONCLUSIONS: The short term results were good and we believe the injection of osteoblast in the avascular lesion of head of femur is a less invasive procedure devoid of any untoward complications and merits such treatment in large patient group with longer follow up.

Mediastinal and abdominal node dissection for carcinoma of thoracic and abdominal esophagus

To evaluate the safety and complications of mediastinal and abdominal dissection in association with subtotal and total esophagectomy for carcinoma of thoracic and abdominal esophagus. 29 patients having curable carcinoma of the esophagus underwent mediastinal and abdominal node dissection. Subtotal esophagectomy was performed in 16 patients while total esophagectomy was performed in 13 patients. Pathological staging was: stage I 0%, stage IIA 24%, stage IIB 62% and stage III 13%. Positive mediastinal and celiac lymph nodes was found in 38% with a mean number of 6 [range1 -12]. The mean number of dissected lymph nodes was 14 [range 8 - 34]. Chest infection occurred in 27%. Early surgical complications were intrathoracic anastomotic leakage 6%, cervical leakage 10%, anastomotic bleeding in one patient and recurrent laryngeal nerve palsy in two patients. Postoperative mortality was 10%. Four patients had locoregional recurrence. Three-year survival rate were 21% for stage IIA and ranged from 11- 0% for stage IIB and III. The technique of mediastinal and abdominal dissection can be performed with subtotal and total esophagectomy with low rate of complications. This leads to more accurate staging, but it is unclear from this small study whether it has an impact on the survival or not

Evaluation of operative treatment for unstable acetabular fractures

We report a combined prospective and retrospective study of 63 acetabular fractures treated by open reduction and internal fixation. The average age of the patients at the time of injury was 32 years. Reduction leaving displacement of one to two mm was achieved in 51 hips [81%]. Follow-up was with an average of 8.7 years [range 2 to 16 years]. We obtained good or excellent functional results in 47 patients [74.5%] and good or excellent radiological results in 44 patients [70%] and there was strong correlation between the functional and radiological results [p =0.0001]. Anatomical reduction was the most predictive of good or excellent results [p = 0.002]. Total hip arthroplasty or arthrodesis had been performed in 16 patients [25%] who had late symptomatic degenerative changes, so promising short term results of open reduction and internal fixation of acetabular fractures are of limited value and long term studies should be considered

Effect of lighting programmes and growth promoters on duck performance

Body weight of Muscovy ducks was higher than under continuous light [23hr light, 1hr Dark] during hot months of the year compared to intermittent light [21ight, 4 dark]. The latter showed higher body weight than during cold months. Avotan supplementation was better during cold months versus to Fermatce- 500 which was better during hot months. Feed conversion under Feed conversion under the intermittent light was better than that of continuous during either cold or hot months. Growth promoters Avotan and Fermatce-500 improved feed conversion under both cold and hot months. Growth promoters lowered mortality rate

Psychiatric morbidity among attendants of internal medicine out-patient clinic in Ismalia general hospital

Cross sectional survey was done to identify the extent to psychiatric disorders among the attendants of Internal Medicine Clinic. A total of 252 patients were taken by systemic random sample. Two stages screening design was adapted in this study. In the first stage, the total sample was screened for the presence or absence of psychological disorders by the General Health Questionnaire [GHQ]. In the second stage, the GHQ positive [+ ve] [probable cases] were interviewed using a Psychiatric Assessment Schedule [PAS]. One hundred and four patients had scored above the cute-off point [41.27%] and they were statistically significant in females, adult period, married persons. Mood disorders were the commonest disorders [35.57%] followed by anxiety disorders [28.84%] and adjustment disorders were 15.38%. The most common physical symptoms associated with psychiatric disorders were abdominal pain, headache, dyspnea, drowsiness, chest pain, backache and palpitations. The importance of secondary prevention was discussed

four year experience in vascular access procedures for hemodialysis in chronic renal failure

From Jan. 1, 1984 to Dec. 30, 1987 a total number of 567 vascular access operations were performed in 567 patients for long term hemodialysis at 15 different centres for five nephrology groups 340 were males and 227 were females. Their age ranged from 14 to 63 years [53.7 years]. Different types of procedures were utilized namely: radiocephalic fistula in 478, Basilo-ulnar fistula in 15, Brachio cephalic fistula in 20, Saphenous vein autograft in 8, polytetra flueroethylene [PTFE] grafts in 38, and central venous access. All patients showed satisfactory results in a follow up period from 2 months to 4 years [average 14 months]. Certain complications occurred, namely:thrombosis in 66, aneurysm formation in 22, venous hypertension in 18 heart failure in 6. steal syndrome in 4 and infection in 3, in conclusion, we advocate the Cimino Brescia [RCAV] fistula as the shunt of choice for initial vascular access and other surgical procedures should be preserved as alternative solutions when the RCAV fistula fails or complicates